This application is in response to AHCPR RFA HS-98-005. It will use data currently being collected on established clinical performance measures for patients with an acute myocardial infarction (AMI), congestive heart failure (CHF), or hypertension. Because we are able to use these timely clinical performance data collected as part of Q- SPAN, we will save approximately one quarter of a million dollars in direct costs for chart abstraction and patient surveys as part of RFA 98-005. The patients in the study were cared for in one of four Health Plans (Allina, Pacificare, Prudential and United Health Care) in six different sites in CY97. Many of the performance measures are in the HEDIS testing, reporting or likely (for 2000) data sets. Most of them involve ambulatory care, but a few are based on hospital care as well. Through surveys with medical directors and administrators of medical groups we will augment the above data with information on financial incentives and managerial practices that were operative during the care of the patients in the study. We will develop an approach for characterizing and understanding the influence of financial incentives and certain management strategies (information feedback and use of clinical teams and specific management programs) on clinical care and associated clinical performance measures. We will look at clinical performance measures in five areas (appropriate drug therapy, medical advice regarding risk modification, appropriate diagnostic tests, general information for the patient, and compliance with medical advice). Finally, we will then link these incentives and managerial strategies to the available clinical performance data to determine the extent to which they influence care patterns.